Calciphylaxis: A systematic review of existing and emerging therapies

Vedvyas, Chetan; Winterfield, Laura; Vleugels, Ruth Ann

doi:10.1016/j.jaad.2011.06.009

Cited by 120 publications

(129 citation statements)

References 108 publications

(160 reference statements)

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“…However, parathyroidectomy may be required for those patients with significant iPTH elevations (.300 ng/L). Survival benefit has not been consistently shown in small case series or larger retrospective studies (74,75,88,89).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Metabolic factors, systemic inflammation, oxidative stress, and endothelial injury along with certain triggers have been implicated. Risk/triggering factors include local trauma, women (73,74), Caucasian ethnicity (75), hypoalbuminemia (72,74,75), therapy with calcium salts, vitamin D supplements, erythropoiesis-stimulating agents (69,70,76), warfarin (72)(73)(74)77), and iron supplements (78). Other independent risk factors include obesity (body mass index.30 kg/m 2 ) (69,73,74), liver disease (69,79), and systemic corticosteroids (65,69,73,74).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Lowering the calcium concentration in the dialysate to 1.0-1.5 mEq/L as tolerated and intensifying dialysis to four to six times per week have been used (76,77). Bisphosphonates, both intravenous and oral preparations, have been used successfully, resulting in pain relief within days and lesion resolution within weeks (75,85,86). Although bisphosphonate use is controversial in those patients with a GFR,30 ml/min because of the potential risk of adynamic bone disease and direct nephrotoxicity (87), the benefit of decreasing morbidity and/or mortality in the case of CUA outweighs the risks.…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Sodium thiosulfate also enhances antioxidant glutathione production, has vasodilatory properties by increasing endothelial nitric oxide production, and can reduce inflammation (75,80,90). It has been shown to relieve pain within days and lead to wound healing in approximately 8 weeks (75).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

“…Several recent case reports suggest that Cinacalcet, a calcimimetic agent that increases parathyroid cell calcium sensitivity, can be used successfully in patients with normal and elevated PTH levels to normalize electrolyte levels and may serve as a medical alternative to parathyroidectomy (75,76,91,92). Optimizing the nutritional status and if needed, albumin replacement in select patients may be beneficial (75).…”

Section: Metastatic Calcificationmentioning

confidence: 99%

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Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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SummaryA broad range of skin diseases occurs in patients with ESRD: from the benign and asymptomatic to the physically disabling and life-threatening. Many of them negatively impact on quality of life. Their early recognition and treatment are essential in reducing morbidity and mortality. The cutaneous manifestations can be divided into two main categories: nonspecific and specific. The nonspecific manifestations are commonly seen and include skin color changes, xerosis, half-and-half nails, and pruritus. The specific disorders include acquired perforating dermatosis, bullous dermatoses, metastatic calcification, and nephrogenic systemic fibrosis. This review article describes these conditions and considers the underlying pathophysiology, clinical presentations, diagnosis, and treatment options.

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Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

Section: Metastatic Calcificationmentioning

confidence: 99%

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Cutaneous Manifestations of ESRD

Galperin

Cronin

Leslie

2014

Clinical Journal of the American Society of Nephrology

193

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Warfarin-Associated Nonuremic Calciphylaxis

Bhutani

Kornik

et al. 2017

JAMA Dermatol

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IMPORTANCE Classic calciphylaxis associated with renal failure is a life-threatening disease. Warfarin-associated calciphylaxis without renal injury has been described, but whether it is a subset of classic calciphylaxis or a different entity remains unknown. We describe 1 case of warfarin-associated calciphylaxis, present data from 2 others from our institution, and review all cases of warfarin-associated calciphylaxis available in the literature. Our review indicates that warfarin-associated calciphylaxis is clinically and pathophysiologically distinct from classic calciphylaxis. OBJECTIVE To review warfarin-associated calciphylaxis and determine its relationship to classic calciphylaxis. DESIGN, SETTING, AND PARTICIPANTSWe searched MEDLINE and Ovid without language or date restrictions for case reports of calciphylaxis from the inpatient setting using the terms "calciphylaxis and warfarin," "non-uremic calciphylaxis," and "nonuremic calciphylaxis." We defined nonuremic calciphylaxis as a histopathologic diagnosis of calciphylaxis without severe kidney disease (serum creatinine level >3 mg/dL; glomerular filtration rate <15 mL/min; acute kidney injury requiring dialysis; and renal transplantation).EXPOSURES Each patient had been exposed to warfarin before the onset of calciphylaxis.MAIN OUTCOMES AND MEASURES Patient data were abstracted from published reports. Original patient medical records were requested and reviewed when possible. RESULTSWe identified 18 patients with nonuremic calciphylaxis, 15 from the literature, and 3 from our institution. Patients were predominantly female (15 of 18 [83%]) with ages ranging from 19 to 86 years. Duration of warfarin therapy prior to calciphylaxis onset averaged 32 months. Lesions were usually located below the knees (in 12 of 18 [67%]). No cases reported elevated calcium-phosphate products (0 of 17 [0%]). Calcifications were most often noted in the tunica media (n = 8 [44%]) or in the vessel lumen and tunica intima (n = 7 [39%]). The most common treatments included substitution of heparin or low-molecular weight heparin for warfarin (n = 13 [72%]), intravenous sodium thiosulfate (n = 9 [50%]), and hyperbaric oxygen (n = 3 [17%]). The survival rate on hospital discharge was remarkably high, with 15 cases (83%) reporting full recovery and 3 cases ending in death. CONCLUSIONS AND RELEVANCEWarfarin-associated calciphylaxis is distinct from classic calciphylaxis in pathogenesis, course, and, particularly, outcome. This finding should influence clinical management of the disease and informs targeted treatment of the disease.

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